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Information on Managed-Care Medicare

Medicare Part C, also called Medicare Advantage Plans, offers Medicare recipients the opportunity to participate in a managed-care plan. Medicare Advantage Plans are managed care plans such as Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). Medicare Part C replaces the need for Medicare Part A (hospitalization) and Part B (medical insurance). Many Medicare Advantage Plans also feature Medicare Part D, prescription coverage.

  1. Managed-Care Plan Types

    • Standard managed-care plans include HMO and PPO plans. These plans are designed to save costs incurred by other types of Medicare and private insurance plans. HMOs are the least expensive but are the most restrictive. You are limited to a specific network of providers and all care must be directed by your primary care provider. Though more expensive, PPOs allow greater flexibility to see the providers of your choice, however you'll receive the greatest discounts by seeking care from a network provider. Medicare Advantage also offer more expensive non-managed care plans.

    Medicare Plan Finder

    • The costs of each Medicare Advantage Plan vary based on carrier, benefits covered, plan type, deductibles and coinsurance. If you aren't sure where to start in finding and comparing available Medicare managed care plans, Medicare developed a tool to make this process easy. On the Medicare. website (see Resources), use the "Medicare Plan Finder" and complete a brief questionnaire to find available plans. The results will display in a list format and you can view a comparison of each plan's estimated costs including premiums, deductibles, drug costs (if you input the drugs you take) and plan rating.

    Enrollment Periods

    • You have the opportunity to sign up for a Medicare Advantage Plan three months before and after you turn 65. To make changes any other time, you must follow Medicare's enrollment schedule. Between November 15 and December 31 of each year you can enroll in a Medicare Advantage Plan. Only in rare circumstances, such as if a carrier drops its Medicare Advantage Plan or you move out of your current plan's service area, can you make a change outside of this tim. Changes made during the enrollment period are effective on January 1 of the next year.

    Resources

    • Medicare offers a variety of resources to help individuals with their Medicare plan choices, including managed-care plan options. The Medicare website provides plentiful information about your options. Additionally, you can call Medicare at 800-633-4227 to speak with a consumer representative for more information. Your State Health Insurance Assistance Program (SHIP) also provides free insurance assistance to eligible individuals.

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